Despite intensive prevention efforts from federal and state agencies, suicide is now the 10th leading cause of mortality overall in the US, increasing steadily over the past two decades and claiming more than 47,000 lives in 2017. The impact of suicide is particularly high among vulnerable populations such as adolescents and formerly incarcerated individuals. Suicide attempts also exact a high emotional, physical, and economic toll. Although much research has focused on causes and predictors of death from suicide, progress in suicide prevention has been hampered by data linkage and methodological challenges. While national mortality rates are known, entities with the potential to implement large suicide prevention initiatives ? health systems, insurers, and departments of corrections ? lack the linked data to monitor suicide incidence in their populations, establish benchmarks, and establish an evaluation framework for prevention efforts. Many individuals who die from suicide have had recent contact with a health care, health insurance, or correctional system, representing critical missed opportunities to implement suicide prevention measures. Two key needs are highlighted by the present RFA: linked surveillance systems that integrate healthcare, insurer (private and public), and correctional data with mortality outcomes to provide a framework for implementing and evaluating suicide prevention initiatives, and large and adequately powered datasets with rich health care access information over an extended period, matched with rigorous study designs for observational data. Therefore, our objective in the current proposal is to establish an in-depth suicide surveillance system linking multiple large, comprehensive databases and use that system to define suicide mortality benchmarks, identify predictors of suicide risk, generate risk prediction tools, evaluate suicide prevention efforts, and establish long-term workflow protocols to sustain the surveillance system. Our team is uniquely positioned to address these needs through our deep expertise in suicide, mental health, and health care utilization research; our extensive experience in application of rigorous epidemiological methods to large linked databases; our established access to comprehensive, regularly updated databases representing health care encounters, public and private insurance claims, corrections data, and suicide deaths in one of the most populous states in the US; and our successful work in prior projects to link all of these databases at the individual level using all appropriate safeguards and security measures. This project will be the first to link these large state- and healthcare system-level databases to establish an ongoing suicide surveillance system to identify short and long term predictors of suicide and to inform and evaluate suicide prevention efforts in North Carolina and across the United States. We anticipate such suicide prevention efforts will get embedded in healthcare systems where at-risk individuals can be identified and referred for prevention and care, thereby preventing suicides and reducing their societal impacts.

Public Health Relevance

This project will define suicide mortality rates for four key target populations of patients either engaged in health care, privately or publicly insured, or recently released from prison; will define clinical predictors of suicide mortality risk; will evaluate the impact of a health care system-delivered routine suicidal risk assessment protocol on suicide mortality risk; and will lay the groundwork for the ongoing continuation of the suicide mortality surveillance system.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
1R01MH124752-01
Application #
10104283
Study Section
Special Emphasis Panel (ZMH1)
Program Officer
O'Connor, Stephen
Project Start
2020-09-09
Project End
2024-06-30
Budget Start
2020-09-09
Budget End
2021-06-30
Support Year
1
Fiscal Year
2020
Total Cost
Indirect Cost
Name
University of North Carolina Chapel Hill
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
608195277
City
Chapel Hill
State
NC
Country
United States
Zip Code
27599